Generalized Tonic Clonic Seizures in Children

Medically reviewed by Drugs.com. Last updated on May 6, 2024.

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What are generalized tonic-clonic seizures?

A generalized tonic-clonic seizure may also be called a grand mal seizure. A seizure means an abnormal area in your child's brain sometimes sends bursts of electrical activity. A generalized seizure affects both sides of the brain. Tonic and clonic are phases that happen during the seizure. The tonic phase causes your child's muscles to become stiff. He or she loses consciousness and may fall down. The clonic phase causes convulsions (repeated muscle contractions). A seizure may last from a few seconds up to 3 minutes. It is an emergency if it lasts longer than 5 minutes.

What increases my child's risk for tonic-clonic seizures?

• Epilepsy
• A family history of epilepsy or seizures
• A brain injury, head trauma, infection, tumor, or stroke
• Blood vessel problems in the brain
• A lack of sleep
• Very low glucose (sugar), sodium (salt), calcium, or magnesium levels

What are the signs and symptoms of a tonic-clonic seizure?

• Sudden loss of consciousness
• Convulsions
• Crying out
• Not responding when spoken to
• Biting his or her lips or cheeks
• Loss of bladder control
• Confusion and lack of energy after the seizure stops

How are tonic-clonic seizures diagnosed?

Your child's healthcare provider will ask about your child's health conditions and medicines he or she takes. Epilepsy is usually diagnosed if your child has at least 2 seizures within 24 hours. It may also be diagnosed if he or she has 1 seizure but is likely to have more. A brain scan or electroencephalogram (EEG) may also show signs of epilepsy that make another seizure likely. Tell the provider how close together the seizures were if your child had more than one. The provider will ask for a detailed description of each seizure. If you did not see the seizure happen, try to bring someone with you who did. Your child may also need any of the following:

• Blood tests may show the cause of your child's seizures. The tests may be used to check your child's blood glucose, sodium, calcium, or potassium levels.
• An EEG records the electrical activity of your child's brain. It is used to find changes in the normal patterns of his or her brain activity.
• CT or MRI pictures may be used to check for injuries or abnormal areas in your child's brain. Your child may be given contrast liquid to help his or her brain show up better in the pictures. Tell the healthcare provider if your child has ever had an allergic reaction to contrast liquid. Do not let your child enter the MRI room with anything metal. Metal can cause serious injury. Tell the healthcare provider if your child has any metal in or on his or her body.
• A PET scan is used to see activity in areas of your child's brain. Your child is given radioactive material that helps healthcare providers see the activity better.
• A SPECT scan uses radioactive material to find where the seizure started in your child's brain. This scan may be done if other scans do not show where the seizure started.

How are tonic-clonic seizures treated?

Your child's healthcare provider may treat any health conditions causing the seizures. The goal of treatment is to try to stop the seizures completely. Your child may need any of the following:

• Medicines may be given to treat certain health conditions. Your child may need antiepileptic medicine if the seizures are caused by epilepsy. He or she may need medicine daily to prevent seizures or during a seizure to stop it. Do not let your child stop taking the medicine unless directed by a healthcare provider.
• A ketogenic diet may be needed to control your child's seizures if medicine does not work. The diet may be suggested by your child's healthcare provider and monitored by a dietitian.
• Surgery may help reduce how often your child has seizures. This may be used if he or she has epilepsy and medicine does not help. Ask your child's healthcare provider for more information about surgery for epilepsy.

Treatment options

The following list of medications are related to or used in the treatment of this condition.

• Keppra
• Diastat
• Xcopri
• Valtoco
• Dilantin

View more treatment options

What can I do to help my child prevent a tonic-clonic seizure?

You may not be able to prevent every seizure. The following can help you and your child manage triggers that may make a seizure start:

• Have your child take antiseizure medicine every day at the same time. This will also help prevent medicine side effects. Set an alarm to help remind you and your child.
• Help your child manage stress. Stress can be a trigger for epilepsy. Exercise can help your child reduce stress. Talk to your child's healthcare provider about exercise that is safe for your child. Illness can be a form of stress. Offer your child a variety of healthy foods and give plenty of liquids during an illness. Talk to your healthcare provider about other ways to manage stress.
• Set a regular sleep schedule. A lack of sleep can trigger a seizure. Try to have your child go to sleep and wake up at the same time every day. Keep your child's bedroom quiet and dark. Talk to your healthcare provider if your child is having trouble sleeping.

What can I do to help my child manage tonic-clonic seizures?

The following can help you manage the seizures if your child has more than one:

• Keep a seizure diary. This can help you find your child's triggers and avoid them. Possible triggers include illness, lack of sleep, hormone changes, lights, and stress. Write down the dates of the seizures, where your child was, and what he or she was doing. Include how he or she felt before and after.
• Record any auras your child has before a seizure. An aura is a sign that your child is about to have a seizure. Auras happen before certain types of seizures that are in only 1 part of the brain. The aura may happen seconds before a seizure, or up to an hour before. Your child may feel, see, hear, or smell something. Examples include part of your child's body becoming hot. He or she may see a flash of light or hear something. He or she may have anxiety or déjà vu. If your child has an aura, include it in the seizure diary.
• Talk to your child about the seizure. Your child may be frightened or confused after a seizure. Depending on your child's age, it might be helpful to explain the seizure. If your child has epilepsy, help your child understand how epilepsy will affect him or her. Help your child learn safety precautions to take. Ask your child about any auras he or she had before the seizure. Help him or her learn to recognize an aura and get to a safe place before the seizure starts.
• Ask what safety precautions your child should take. Talk with your adolescent's healthcare provider about driving. Your adolescent may not be able to drive until he or she is seizure-free for a period of time. You will need to check the law where he or she lives. Also talk to your child's healthcare provider about swimming and bathing. He or she may drown or develop life-threatening heart or lung damage if a seizure happens in water.
• Have your child carry medical alert identification. Have your child wear medical alert jewelry or carry a card that says he or she has tonic-clonic seizures. Ask your healthcare provider where to get these items.
• Create a care plan. Tell family, friends, school officials, and babysitters about your child's epilepsy. Your adolescent should also tell his or her coworkers if needed. Give others instructions that tell them how they can keep your child safe if he or she has a seizure.

How can others keep my child safe during a seizure?

Give the following to your child's family, friends, babysitters, school officials, and coworkers:

• Do not panic.
• Note the start time of the seizure. Record how long it lasts.
• Gently guide your child to the floor or a soft surface. Cushion the child's head and remove sharp objects from the area around him or her.
• Place your child on his or her side to help prevent him or her from swallowing saliva or vomit.
• Loosen the clothing around your child's head and neck.
• Remove any objects from your child's mouth. Do not put anything in your child's mouth. This may prevent him or her from breathing.
• Perform CPR if your child stops breathing or you cannot feel his or her pulse.
• Let your child sleep or rest after his or her seizure. He or she may be confused for a short time after the seizure. Do not give your child anything to eat or drink until he or she is fully awake.

What do I need to know about stopping my child's medicine?

Your child's healthcare provider can help you understand and make decisions about antiseizure medicines. Do not stop giving your child the medicine until his or her healthcare provider says it is okay. Your child will need to have no seizures for a period of time, such as 18 to 24 months. Then you and the provider can decide if your child should continue taking the medicine. The provider will lower your child's dose over a certain period of time. Seizures might happen again while your child stops taking the medicine, or after he or she stops. Rarely, these seizures no longer respond to medicines. Tests such as an EEG may be useful in helping you and your child's provider make medicine decisions.

Call your local emergency number (911 in the US) for any of the following:

• This is the first seizure your child has ever had.
• Your child has a second seizure within 24 hours of the first.
• Your child has trouble breathing or feeling alert after a seizure.
• The seizure lasts longer than 5 minutes.
• Your child had a seizure in water, such as in a swimming pool or hot tub.

When should I call my child's doctor?

• Your child is injured during a seizure.
• Your child feels he or she is not able to cope with having tonic-clonic seizures.
• Your child's seizures start to happen more often.
• Your child is confused longer than usual after a seizure.
• You have questions or concerns about your child's condition or care.

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's healthcare providers to decide what care you want for your child. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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